Someone Turning 65 Has Close to a 70% Chance of Needing Long-Term Care. Here’s What the Average American Can Realistically Plan For

Long-term care can mean something as simple as needing help with everyday tasks like bathing, dressing, eating, or getting around. For many retirees, the big unknown is whether they’ll need that help and for how long. The federal government’s own estimate is that 70% of adults who live to age 65 will develop severe long-term care needs before they die.

That figure comes from a 2019 brief published by the Department of Health and Human Services, which drew on Health and Retirement Study data from 1995 to 2014. Most people still assume it won’t happen to them, partly because the care often looks different from the nursing home picture they have in mind.

Most Care Ends Up Shorter and Closer to Home Than Expected

That same federal study found a big gap between needing care and paying for it. Only 48% of people turning 65 receive any paid care over their lifetime. The researchers highlight widespread reliance on unpaid care. Many older adults with severe needs rely only on family and other unpaid caregivers, so a spouse or an adult child often does the work without a bill ever showing up.

Paid care also tends to be short: only 24% of older adults get more than two years of paid care, and only 15% spend more than two years in a nursing home. The risk isn’t spread equally, though. The brief notes that long periods of need and paid care are much more common among people with few financial resources than among wealthier families.

Medicare Covers Rehab, Medicaid Covers What’s Left After Savings Run Out

Medicare.gov says simply that Medicare generally doesn’t pay for ongoing care in a nursing home. What it does cover is skilled nursing facility care, meaning rehab or nursing care that requires a professional, and only for a limited time after a qualifying inpatient hospital stay of at least 3 days in a row. Even then, it costs money. In 2026, patients generally pay $0 per day for the first 20 days of covered skilled nursing care and $217 per day for days 21 through 100.

Because of that, Medicare says most people who move into a nursing home start out paying the bill themselves, and Medicaid can cover long-term nursing home care for people who meet their state’s eligibility requirements. The rules differ from state to state, and residents may have to “spend down” their savings before they qualify, but CMS guidance says Medicaid pays for nursing home care only when no other source is available. Our earlier coverage goes through state Medicaid rules in more detail.

Retirement Income Has to Cover Care Costs, Too

Most families start with monthly income. The average retired worker’s Social Security check is $2,071 after the 2026 cost-of-living adjustment, and the 2027 adjustment is set at 3.6%. The standard Medicare Part B premium of $202.90 a month usually comes out of that check first. Advisor Wes Moss described the overlap on a 2026 episode of the Clark Howard podcast: “Your income in retirement planning doubles as your long-term care planning as well.”

Five Planning Approaches Within Reach for Typical Households

Each approach rests on a different assumption about how much care will be needed and who’ll provide it.

1. A dedicated care fund. This assumes care will be shorter or mostly at home, which matches the federal data for many people. On the same podcast, Moss said families with “$3 million plus” can self-insure, and he called the families between the wealthy and the asset-poor the “muddy middle.”
2. Traditional long-term care insurance. Medicare.gov notes these policies can cover both skilled and non-skilled care, but coverage varies a lot from policy to policy. Premiums aren’t locked in, and our coverage of recent premium increases looks at what policyholders have faced.
3. Hybrid policies. Some insurers let a life insurance policy pay for ongoing care. This approach assumes the money goes either toward care or to heirs.
4. Home equity. Federal Reserve data show families ages 70 and older held about $13.57 trillion in owner-occupied real estate in the second quarter of 2026. That’s a combined total, though. It doesn’t say what any one family could actually draw on.
5. Medicaid planning. This assumes savings will eventually run out, and it relies on state rules that elder law attorneys work with.

Taxes can ease the cost of insurance. IRS Publication 969 says long-term care insurance premiums count as qualified medical expenses for an HSA, up to limits that depend on age and change each year. Our piece on paying premiums from an HSA covers those limits, and a separate article looks at how big a dividend portfolio would need to be to pay a nursing home bill.

One Family Conversation Worth Having This Year

The federal data point to family as the most common source of care, so the planning discussion usually comes back to family members, and that conversation tends to cover who could realistically provide help at home and where care would happen if home stops working. It also covers which mix of income, savings, insurance, or home equity would pay for it. It’s easier to have that talk while everyone is healthy, since the choices narrow quickly after a diagnosis or a hospital discharge.

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